Eczema
Treatment of dry, inflamed and itchy skin conditions with a focus on controlling triggers and flare-ups
What is eczema?
Eczema is inflammation in skin whose outer barrier does not hold water well. That barrier is meant to keep moisture in and irritants out; in eczema it is leaky, so the skin dries, cracks, and lets through substances that the immune system then reacts to.
Part of the fault is inherited, and eczema often travels in families alongside asthma and hay fever. The rest is the environment acting on that weak barrier: soap and detergent, hard water, heat and sweat, woollen and synthetic fabric, dust, and stretches of stress or poor sleep.
It runs in flares. Scratching is central to it, since scratching damages the barrier further and provokes more inflammation, so the itching continues after the original trigger has gone.
What you might notice
- Itchy dry patches of skin
How it is diagnosed
Your doctor diagnoses eczema by examining the skin and by where the inflammation sits, which changes with age: the face and the outer limbs in babies, the creases of the elbows and knees in older children and adults, and the hands in people whose work keeps them wet.
They will ask what your skin is like between flares, what you wash with, whether anyone in the family has eczema, asthma or hay fever, what your work involves, and what you have applied so far. They will look for signs that the skin has become infected, since infected eczema is treated differently and is easy to miss under the redness.
Where a particular substance is suspected of triggering it, your doctor may arrange testing to identify what your skin is reacting to.
Recovery
A flare treated properly settles over one to two weeks. The itch eases first, the redness next, and the roughness last, and the skin usually stays discoloured for weeks after it has healed, which is part of the healing instead of a sign of failure.
Moisturiser is the part that continues. It is applied generously, several times a day, on good days as well as bad, and this is what stretches out the gap between flares. Most people use far too little of it.
Eczema in children often improves a great deal through childhood, and many outgrow the worst of it, though the skin usually stays dry and easily irritated for life. Adults with hand eczema recover more slowly, over four to six weeks, and need protection at work to hold the result. There is no time off school or work.
If it is left untreated
A mild dry patch can be managed with moisturiser alone and needs nothing more.
Left untreated, a flare gets into a cycle: the skin itches, scratching breaks it, the break inflames, and the itch increases. Sleep goes first, and disturbed sleep affects concentration, school and mood as much as the skin does. Skin scratched over months thickens into leathery patches that take far longer to settle than a fresh flare.
Broken skin also becomes infected. Weeping, yellow crusting, increasing pain or a fever means bacterial infection and needs seeing promptly. One situation needs same-day care: a rapid spread of small painful blisters or punched-out sores, often with fever, which is a viral infection on top of eczema and is treated urgently.
Questions about eczema
Will my child grow out of it?
Many children improve substantially. Eczema that begins in infancy often becomes much milder through childhood, and a good proportion of children have little active disease by their teens, though the skin usually remains dry and easily irritated for life and can flare in adulthood under the right conditions. Eczema that starts later, or that comes with asthma and hay fever, tends to be more persistent. Nothing is lost by treating it well in the meantime: controlling flares protects sleep and growth and stops the skin thickening.
Are steroid creams safe to use on my skin?
Used as prescribed they are safe, and the harm people fear comes from using the wrong strength in the wrong place or applying a strong one continuously for months. Your doctor matches the strength to the site, since facial and fold skin is thin and needs a milder preparation, and prescribes it for a defined number of days to bring a flare down. The commoner problem in practice is using too little for too short a time, so the flare never settles and the cream is blamed. Ask exactly how much, where, and for how many days.
Do I need to cut foods out of my diet?
Usually no. Food allergy genuinely contributes in a minority of infants with severe eczema, and in that situation it is identified with proper testing and supervision. In older children and adults, removing foods rarely improves eczema and regularly causes poor nutrition and anxiety at mealtimes. If you notice a consistent flare within a couple of hours of a particular food, tell your doctor and let them test it instead of cutting the food out on your own. The larger gains come from moisturiser, avoiding soap and detergent, and treating flares early.
Other dermatology & cosmetology treatments
Treatment of acne and acne-related marks based on skin type, severity and recurrence
Day CareEvaluation and treatment of uneven skin tone, dark spots and other pigmentation concerns
Day CareTalk to a care coordinator about eczema
Leave a number and a care coordinator calls you back with what the treatment involves and which hospital it would be at. They book a consult only if you want one